Provider Demographics
NPI:1982418562
Name:WILSON, OLIVIA KAZIAH (NP)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:KAZIAH
Last Name:WILSON
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 LOGAN LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-5071
Mailing Address - Country:US
Mailing Address - Phone:423-619-9426
Mailing Address - Fax:
Practice Address - Street 1:513 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-3402
Practice Address - Country:US
Practice Address - Phone:423-619-9426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38123363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily